Day 1 :
Keynote Forum
Satoko Tsuru
University of Tokyo, Japan
Keynote: Logical design of the nursing observation for the quality improvement of the pediatric team medicine
Biography:
Satoko Tsuru has completed her PhD from Hiroshima University, School of Medicine. She is a Professor in Quality and Health Social System Engineering Laboratory,School of Engineering, The University of Tokyo. She has published more than 150 papers in academic journals and has been serving as some board member of academic association in nursing, medical and engineering in Japan.
Abstract:
The team medicine with doctors and nurses is strongly demanded in pediatric healthcare. However, a treatment plan by medical doctor and the observation plan by nurse tend to be managed each side in Japan. It needs long time to agree what you observe for each patient. The existence of the realistic problem is suggested with the reason. Therefore we tried the visualization of the clinical process of the Kawasaki disease using PCAPS which was structured technique of the clinical knowledge. We use NursingNAVI and Nursing observation master in PCAPS.
Keynote Forum
Christine Guarnieri
NYU Winthrop Hospital, USA
Keynote: Navigating colorectal and pancreatic cancer patients in a multidisciplinary cancer center
Biography:
After a 20 plus career working in the private sector for a fortune 500 company, Christine fulfilled her goal of becoming a Registered Nurse. She began her nursing career in 2006 at Huntington Hospital where she worked on a medical / surgical unit until 2007 when she transferred to Oncology. Christine completed her undergraduate degree in Nursing at Stony Brook University and completed her Master of Nursing Education at the University of Phoenix, Arizona. She is certified on Oncology, Chemotherapy, Biotherapy, and Gerontology. She is the recipient of the Huntington Hospital Magnet Nurse Award, Nominee of the NS/LIJ Health System President’s award and Service Excellence Award. Christine joined Winthrop-University Hospital in 2011 as an Oncology Nurse Navigator specializing in colorectal, gastrointestinal, pancreatic, and head & neck cancers. Christine has been interviewed by the Association of Community Cancer Centers publication “Oncology Issues” for her role as an Oncology Nurse Navigator and the effective practices in a Multidisciplinary Pancreatic Cancer Program. Recently, she shared her expertise in Oncology Nurse Navigation at the NYU Winthrop Cancer Survivors Awareness and Education, Oncology Nurse Advisor Navigation Summit, Austin Texas, and has presented at multiple medical and nursing Grand Rounds on the topic of Oncology Nurse Navigation. She also served as President of the Oncology Nursing Society, Long Island-Queens local chapter from 2015-2017.
Abstract:
- Pediatric Healthcare | Pediatric Oncology | Pediatric Cardiology | Child Right & Child Safety | Pediatric Bioethics | Pediatric Psychology | Pediatric Gynecology | Pediatric Vaccines | Pediatric Infection & Allergy | Nursing Education & their Innovations | Adult Health Nursing | Surgical Nursing | Healthcare Management | Clinical Nursing | Cardiovascular Nursing | Disaster Nursing
Chair
Vedrana Vejzovic
Malmo University, Sweden
Co-Chair
Huda Al-Awaisi
Sultan Qaboos University Hospital, Oman
Session Introduction
Christiana Nicolaou
Cyprus University of Technology, Cyprus
Title: Health related quality of life in mothers with children with cancer: A systematic review
Biography:
Christiana Nicolaou joined the Department of Nursing, School of Health Sciences, Cyprus University of Technology in 2007 as Senior Lecturer. Currently, she is an Assistant Professor in Pediatric Nursing (since 2011), elected member of the CUT Senate and elected member of the Council of the Department of Nursing (CUT). She worked as Staff Nurse in Pediatric Unit and Neonatal Intensive Care Unit (Archbishop Makarios Hospital, Nicosia, 1987 - 1994) and in a Gynecological and Midwifery Clinic, Nicosia (1986-1987). She has received her Diploma in General Nursing from School of Nursing, Cyprus (1985), a BSc (Honors) in Professional Studies (Nurse Education) from Anglia Polytechnic University, UK (1997), a Certificate in Teaching and Learning Methodology (Pedagogical Institute of Cyprus, 2001) and her PhD in Epidemiology and Biostatistics from the Cyprus University of Technology (2015). Her area of clinical practice and research is pediatric nursing care and social epidemiology.
Abstract:
Studies among parents of children with cancer have focused on anxiety, depression, or post-traumatic stress, and less so on overall measures, such as health-related quality of life (HRQoL).
Christiana Nicolaou
Cyprus University of Technology, Cyprus
Title: Health related quality of life in mothers with children with cancer: A systematic review
Biography:
Christiana Nicolaou joined the Department of Nursing, School of Health Sciences, Cyprus University of Technology in 2007 as Senior Lecturer. Currently, she is an Assistant Professor in Pediatric Nursing (since 2011), elected member of the CUT Senate and elected member of the Council of the Department of Nursing (CUT). She worked as Staff Nurse in Pediatric Unit and Neonatal Intensive Care Unit (Archbishop Makarios Hospital, Nicosia, 1987 - 1994) and in a Gynecological and Midwifery Clinic, Nicosia (1986-1987). She has received her Diploma in General Nursing from School of Nursing, Cyprus (1985), a BSc (Honors) in Professional Studies (Nurse Education) from Anglia Polytechnic University, UK (1997), a Certificate in Teaching and Learning Methodology (Pedagogical Institute of Cyprus, 2001) and her PhD in Epidemiology and Biostatistics from the Cyprus University of Technology (2015). Her area of clinical practice and research is pediatric nursing care and social epidemiology.
Abstract:
Studies among parents of children with cancer have focused on anxiety, depression, or post-traumatic stress, and less so on overall measures, such as health-related quality of life (HRQoL).
Christiana Nicolaou
Cyprus University of Technology, Cyprus
Title: Health related quality of life in mothers with children with cancer: A systematic review
Biography:
Christiana Nicolaou joined the Department of Nursing, School of Health Sciences, Cyprus University of Technology in 2007 as Senior Lecturer. Currently, she is an Assistant Professor in Pediatric Nursing (since 2011), elected member of the CUT Senate and elected member of the Council of the Department of Nursing (CUT). She worked as Staff Nurse in Pediatric Unit and Neonatal Intensive Care Unit (Archbishop Makarios Hospital, Nicosia, 1987 - 1994) and in a Gynecological and Midwifery Clinic, Nicosia (1986-1987). She has received her Diploma in General Nursing from School of Nursing, Cyprus (1985), a BSc (Honors) in Professional Studies (Nurse Education) from Anglia Polytechnic University, UK (1997), a Certificate in Teaching and Learning Methodology (Pedagogical Institute of Cyprus, 2001) and her PhD in Epidemiology and Biostatistics from the Cyprus University of Technology (2015). Her area of clinical practice and research is pediatric nursing care and social epidemiology.
Abstract:
Studies among parents of children with cancer have focused on anxiety, depression, or post-traumatic stress, and less so on overall measures, such as health-related quality of life (HRQoL).
Christiana Nicolaou
Cyprus University of Technology, Cyprus
Title: Health related quality of life in mothers with children with cancer: A systematic review
Biography:
Christiana Nicolaou joined the Department of Nursing, School of Health Sciences, Cyprus University of Technology in 2007 as Senior Lecturer. Currently, she is an Assistant Professor in Pediatric Nursing (since 2011), elected member of the CUT Senate and elected member of the Council of the Department of Nursing (CUT). She worked as Staff Nurse in Pediatric Unit and Neonatal Intensive Care Unit (Archbishop Makarios Hospital, Nicosia, 1987 - 1994) and in a Gynecological and Midwifery Clinic, Nicosia (1986-1987). She has received her Diploma in General Nursing from School of Nursing, Cyprus (1985), a BSc (Honors) in Professional Studies (Nurse Education) from Anglia Polytechnic University, UK (1997), a Certificate in Teaching and Learning Methodology (Pedagogical Institute of Cyprus, 2001) and her PhD in Epidemiology and Biostatistics from the Cyprus University of Technology (2015). Her area of clinical practice and research is pediatric nursing care and social epidemiology.
Abstract:
Studies among parents of children with cancer have focused on anxiety, depression, or post-traumatic stress, and less so on overall measures, such as health-related quality of life (HRQoL).
Abed N Azab
Ben-Gurion University of the Negev, Israel
Title: Effects of analgesics administration, surgical techniques and parental anxiety on hospital length of stay among post-tonsillectomy children
Biography:
Abed N Azab has completed his Bachelor in Nursing degree and PhD in Pharmacology in Ben-Gurion University of the Negev (Israel). His PhD thesis was focused on the study of anti-inflammatory drugs. As a Post-Doctoral Fellow in Wayne State University (Michigan), he investigated the therapeutic mechanisms of mood-stabilizing drugs. Currently, he is an Assistant Professor in the Faculty of Health Sciences in Ben-Gurion University. The major research projects in his lab are: Studying the role of inflammation in the pathophysiology and treatment of mood disorders; searching for novel therapeutic strategies for mood disorders and; issues in pharmacology that are related to nursing practice.
Abstract:
Tonsillectomy is a surgical procedure in which the tonsils are partially or totally removed. Hospital length of stay (HLOS) is an important predictor of resource utilization.
Nancy Adrianna Garofalo
NorthShore University Health System, USA
Title: OPT-MOM: Oro-pharyngeal therapy with mother’s own milk to protect extremely premature infants against infectious morbidities
Biography:
Nancy A is a Neonatal Nurse Practitioner at the NorthShore University HealthSystem and a Senior Clinician Researcher at the Pritzker School of Medicine, University of Chicago. She received a BSN from Loyola University, an MS in Nursing Administration from Aurora University, an MSN in the Neonatal Nurse Practitioner specialty and also a PhD from Rush University, Chicago IL. Her dissertation introduced the concept of oropharyngeal administration of colostrum into the medical literature, and she is currently leading a multi-center RCT to investigate the immune effects and clinical outcomes of extremely premature infants who receive the OPT-MOM intervention.
Abstract:
Extremely premature infants are born before the last trimester of pregnancy and experience an abrupt cessation of amniotic fluid exposure. Their oropharynx is no longer bathed with protective biofactors, which stimulate the immune system and promote intestinal maturation. Many of these biofactors are highly concentrated in the milk (especially colostrum) expressed by women who deliver extremely premature infants; which suggest an important biological function for facilitating extra-uterine transition. Unfortunately, clinical instability precludes enteral feeding for extremely premature infants in the first days of life. The post-birth fasting leads to intestinal atrophy and abnormal intestinal microbiota which contribute to the pathogenesis of infection. Once started, enteral feeds of mother’s milk are administered via a nasogastric tube, which bypasses the infant’s oropharynx. Oropharyngeal exposure to protective (milk) biofactors does not occur until the infant begins per oral feeds; typically at 32 weeks corrected gestational age. Thus, post-birth oropharyngeal exposure to protective biofactors is delayed for up to 10 weeks for the smallest extremely premature infants; born as early as 22/23 weeks gestation. This deficit has never been addressed in neonatology and may be contributing substantially to prematurity-associated infectious morbidities, including late-onset sepsis and necrotizing enterocolitis. Oropharyngeal therapy with mother’s own milk (OPT-MOM) can serve as an easy, inexpensive oral immune therapy to mimic the protective effects of amniotic fluid exposure for extremely premature infants until per oral feedings can be safely introduced. Current evidence will be presented. Clinical implications and future directions for multidisciplinary research will be discussed.
Fatima Alzahra Abdul Rahman M
International University of Africa, Sudan
Title: Effect of innovative participatory health education program to augment knowledge, attitude Effect of innovative participatory health education program to augment knowledge, attitude and practices of mothers of children with sickle cell anemia
Biography:
Fatima Alzahra Abdul Rahman M has recently had her PhD in Pediatric and Child Health Nursing. Her expertise is in teaching and passion is in improving the health and wellbeing of children specially sicklers. She is a member in Sudan Sickle Cell Anemia center and has attended many training workshops on care and management of sickle cell anemia and integrating palliative care with SCA for nurses and community. She had teaching experience in education institutes and hospitals.
Abstract:
Statement of the Problem: Sickle cell anemia (SCA) is one of the commonest devastating neglected disorders in Sudan particularly in western region in North Darfur State. Most SCA patients are from IDP camps, nomadic tribes with low socioeconomic status and have no real background about the disease. No dedicated center for SCA to provide care for those patients who pose a real financial, physical, psychological burden for affected children and their families.
Purpose: The purpose of this study is to evaluate the effect of an innovative participatory health education program about SCA to augment knowledge, attitude, and practices of mothers of the affected children.
Methodology: A quasi experimental pretest-posttest design was conducted in El Fasher City and three (IDPs) camps. 127 mothers were consecutively selected from El Fasher Hospital general pediatric referral clinic over four months period. Fifteen mother and community outreach members from the same community were trained as peer educators to conduct the health education on SCA for the participants through home visits and community outreach group sessions using simple educational materials prepared for the study. Semi-structured questionnaire used before and after the intervention and six months following the program intervention to assess the knowledge, attitude, and care practices of participants. Data were analyzed by SPSS version 20.
Findings: A statistically significant improvement was found in knowledge, attitude and care practices of caregivers about the disease after the program intervention. Before the intervention, the mean hospitalization rate was 2.3 times in 6 months, where after 6 month from the intervention reduced to 1.8 times.
Recommendations: The use of peer educators from the local community could be an effective approach for increasing knowledge, improving attitudes and practice of care towards SCA.
Ioanna Menikou
Cyprus University of Technology, Cyprus
Title: The effectiveness of non-directive play therapy (NDPT) on children with a medical condition: A scoping review
Biography:
Ioanna Menikou is a PhD candidate at Cyprus University of Technology, School of Nursing. She has completed a two-year Postgraduate course on Thearpeutic Play Skills from The Academy of Play and Child Psychotherapy in collaboration with Leeds Beckett University and accredited by Play Therapy UK and Play Thearpy International.
Abstract:
NDPT is a psychotherapy approach used in children. It is based on the fact that play is the natural means that children use to explore and understand the world, express their thoughts and feelings, and learn self-mastery. NDPT has been developed by Virginia Axline, who was influenced by the person-centered, non-directive approach of Carl Rogers. In our knowledge, this is the first review in the field of NDPT on children with a medical condition.The aim of the review was to identify research evidence on NDPT as an intervention on children with any medical condition. The systematic literature search of databases such as CINAHL Plus, AMED, EMBASE, Ovid MEDLINE, ProQuest Central, PsycInfo, and SCOPUS revealded six studies meeting the eligibility criteria. Despite the fact that there is enough evidence on the effectiveness of NDPT on children with mental, behavioral, or academic problems, there is a paucity of evidence examining the effectiveness of NDPT on children in the medical context. However, a thematic analysis demonstrated a positive effect of NDPT on children with a medical condition on four aspects: overall adjustment, illness-related adjustment, anxiety levels, and play behaviors. The findings of the review can be used to inform programs, procedures, and clinical practice development in pediatric population in order to provide integrated and child-centered care with an age-appropriate intervention to children. Research implications are also discussed.
- Neonatology & Perinatology | Pediatric Cardiology | Pediatric Trauma | Pediatric Surgery | General Pediatrics | Pediatric Neurology | Pediatric Dermatology | Pediatric Obesity | Women Health and Midwifery Nursing | Clinical Nursing | Mental Health and Psychiatry Nursing | Patient Safety Factors | Tele Medicine and E-Health | Healthcare Case Studies
Chair
Salam Hadid
Zefat Academic College, Israel
Co-Chair
Laura Ford
Thompson Rivers University, Canada
Session Introduction
Salam Hadid
Zefat Academic College, Israel
Title: Personal values, value implementation at work and the difference between them
Biography:
Salam Hadid is R.N. that has completed her PhD from Haifa University serves as lecturers at Zefat academic college.
Salam Hadid is R.N. that has completed her PhD from Haifa University serves as lecturers at Zefat academic college.
Abstract:
Abstract:
Background: Nursing staff are characterized by personal values systems, which influence their choices. Schwarz (1992) developed the idea of a universal value system which assists people in coping with the demands of everyday life. The degree to which personal values can be realized in the workplace can vary depending on environment and institutional policy.
Aim: Examining the personal values of nursing staff and the degree to which they implemented them in clinical practice in the workplace and the gap between them. Examining the factors influencing the extent of the gap.
Method: a quantitative descriptive study, based on data collected directly from respondents - nursing staff members - by means of a structured questionnaire: Shorter Schwartz's Value Survey (SSVS), questionnaire on the degree of implementation of personal values in clinical practice based on the SSVS and demographic information questionnaire.
Results: 425 respondents, 289 were women and 127 men, with mean age 39.2 years, from different faiths. Certain values are assigned a very high level of importance compared to others. The degree of value implementation in the clinical field is not uniform. The gap between the importance of a value and the extent to which it can be applied is not always in the same direction. Demographic factors influenced the level of importance, implementation of personal values in clinical practice and the gap between them.
Conclusions and Recommendations: Knowledge of the dominant personal values held by nursing staff may contribute to the organization's ability to cultivate and maintain the human resources within it. Institutions should be aware of possible gaps between the importance of values and the degree of their implementation and that there might be negative effects of the gaps, and should strive to reduce them. This can be achieved by studying the subject, implementing it, and developing a cultural-organizational climate that is adapted to the application of the value profile of nursing professionals, thereby improving the performance of teams, reducing negative effects and improving their professional functioning in general.
Laura Ford
Thompson Rivers University, Canada
Title: Integration of Simulation in an Unfolding Case Study
Biography:
Laura Ford has over 33 years’ experience as a Registered Nurse and completed her MN in 2007 from Athabasca University, Alberta, Canada. She served in the role of Nursing Resource Center Coordinator and was the inaugural Coordinator of the Interprofessional Simulation Center at Thompson Rivers University (TRU), Canada. Currently Laura is a Senior Lecturer with the School of Nursing and a Faculty member for the Return to Registered Nursing program in TRU’s Open Learning Department.
Abstract:
Health care needs have changed as have our practice of educating nurses. Nurses facing challenges of today’s complex practice areas need to be highly skilled, well-educated, critical thinkers ready to take on complex clinical situations. In order to meet these needs, educators are incorporating innovative strategies and technologies to enhance student learning. Students, especially in first year, often having minimal experience in health care are challenged to make linkages between theory, client conditions, assessments and performing skills appropriately in practice (Day, 2011). In 2015, I utilized an unfolding clinical case study in a first-year fundamentals class designed to depict a ‘family’. As the semester, progressed students developed their family based on information provided and their understanding of assessment frameworks. This experience showed an enhanced student engagement, increased transferability to practice, knowledge synthesis and holistic care. This year I intend to further develop the unfolding case study and have students integrate their concept of family into the weekly simulation experiences. Students will utilize knowledge of their Family in a simulated clinical setting, scaffolding knowledge of the family members’ condition, nursing process and skill acquisition. Simulation provides a platform where students can be engaging in a realistic activity, moving knowledge from the theoretical to the practical. A balance between lecture and experiential activities will allow students to utilize knowledge in a realistic environment (Onda, 2012). In this presentation, insights and feedback will illuminate a discussion supporting the use of this teaching strategy with health care students.
Nagwa A Zein El Dein
Menoufia University, Egypt
Title: Effect of a sensory integration program on the development of children with autism
Biography:
Nagwa A Zein El Dein is a Professor of Pediatric Nursing at Menoufia University. She had been working since graduation in 1986 as an Instructor and upgrading until her proficiency. Also, she worked at Philadelphia University, Amman, Jordan as an Associate Professor and as a Quality Assurance Officer. She has many qualifications in teaching critical pediatric nursing, nursing theories, nursing research and many other subjects as pediatric neonatology and rehabilitation. Also, she is participating in conducting nursing thesis and as an evaluator in many. As well as joining in the national project as quality assurance in higher education and project sponsored by HEEPH to reconstruct nursing curriculum through critical thinking skills for accreditation as well as developing learning modules for pediatric nursing course manual procedure of pediatric nursing.
Abstract:
Autism is the most common developmental disorder that causes profound delay in communication, language, cognitive and sensory motor development. The aim of this study was to evaluate the effect of a sensory integration program on the development of children with autism. A quasi experimental design (pre and posttest) was used. A convenient sample of 30 autistic children and their mothers were involved. The study was conducted at Nedaa center for auditory impaired children and Gamayet Kayan for mentally retarded children in Cairo. Seven data collection instruments were utilized (biosocial characteristics of children structured interview questionnaire, childhood autism rating scale (CARS), Wechsler intelligence scale for children, autism social skills profile, sensory profile questionnaire, test of visual –auditory perception and assessment of basic language and learning skills tools). The results of this study showed that after three and six months of sensory integration program majority of children had higher scores for social, sensory, communication, motor and perception development. The study concluded that children who received sensory integration program developed higher cognitive, motor, language, social, perception, attention, communication and sensory abilities on posttest. Therefore, this study recommended that sensory integration program should be integrated as a part of pediatric nursing rehabilitation for autistic children.
Nagwa A Zein El Dein
Menoufia University, Egypt
Title: Effect of a sensory integration program on the development of children with autism
Biography:
Nagwa A Zein El Dein is a Professor of Pediatric Nursing at Menoufia University. She had been working since graduation in 1986 as an Instructor and upgrading until her proficiency. Also, she worked at Philadelphia University, Amman, Jordan as an Associate Professor and as a Quality Assurance Officer. She has many qualifications in teaching critical pediatric nursing, nursing theories, nursing research and many other subjects as pediatric neonatology and rehabilitation. Also, she is participating in conducting nursing thesis and as an evaluator in many. As well as joining in the national project as quality assurance in higher education and project sponsored by HEEPH to reconstruct nursing curriculum through critical thinking skills for accreditation as well as developing learning modules for pediatric nursing course manual procedure of pediatric nursing.
Abstract:
Autism is the most common developmental disorder that causes profound delay in communication, language, cognitive and sensory motor development. The aim of this study was to evaluate the effect of a sensory integration program on the development of children with autism. A quasi experimental design (pre and posttest) was used. A convenient sample of 30 autistic children and their mothers were involved. The study was conducted at Nedaa center for auditory impaired children and Gamayet Kayan for mentally retarded children in Cairo. Seven data collection instruments were utilized (biosocial characteristics of children structured interview questionnaire, childhood autism rating scale (CARS), Wechsler intelligence scale for children, autism social skills profile, sensory profile questionnaire, test of visual –auditory perception and assessment of basic language and learning skills tools). The results of this study showed that after three and six months of sensory integration program majority of children had higher scores for social, sensory, communication, motor and perception development. The study concluded that children who received sensory integration program developed higher cognitive, motor, language, social, perception, attention, communication and sensory abilities on posttest. Therefore, this study recommended that sensory integration program should be integrated as a part of pediatric nursing rehabilitation for autistic children.
Ahmed Al-Smadi
American University of Madaba, Jordan
Title: The Relationship between Anxiety, Post-Traumatic Stress, Insomnia, Demographics and Fibromyalgia among Female
Biography:
Ahmed Mohammad Al-Smadi, PhD, RN, with sixteen years of experience as nurse and researcher. He earned his bachelor’s and master’s degree in nursing from Jordan University of Science and Technology and his PhD in Nursing from University of Ulster, United Kingdom. Currently he is assistant professor in nursing at American University of Madaba- department of medical laboratories. His main research interests are cardiac care, refugees’ health, and psychological health laboratories. His main research interests are cardiac care, refugees’ health, and psychological health
Abstract:
The aim of this study was to examine the predictors of fibromyalgia among female refugees in Jordan. A cross-sectional design was used, and 288 refugees were recruited from four different cities in Jordan. Fibromyalgia impact questionnaire, Hamilton Anxiety Rating Scale, post-traumatic stress disorder, insomnia severity index was used. Logistic regression was used to identify the predictors of fibromyalgia symptoms. The results of the current study showed that 73.62% (N=212) of refugees had moderate to severe fibromyalgia impact. The logistic model was statistically significant (P=0.001). The model explained 59.2% of the variance in fibromyalgia impact and correctly classified 86.2% of the cases. Refugees living in Irbid city were 6.12 times more likely to exhibit higher negative impact of fibromyalgia compared to refuges living in Zarqa city. Syrian refugees were 1.9 times more likely to exhibit higher negative impact of fibromyalgia compared to Iraqi refugees. Increased age was associated with an increased likelihood of exhibit higher negative impact of fibromyalgia with an odds ratio of 1.8. Increased post-traumatic stress disorder (odds ratio=1.13), and anxiety scores (odds ratio=1.15) were associated with higher negative of fibromyalgia symptoms. In conclusion, refugees living in Irbid city, those who were older, anxious, and stressed after displacement, had increased negative impact of fibromyalgia. The study recommends assessing fibromyalgia among all refugees in Jordan and considering the factors associated with fibromyalgia when assessing refugees. In addition, the study suggests that healthcare workers, including nurses, pharmacists and physicians, should implement non-pharmacological and pharmacological interventions to decrease the negative impact of fibromyalgia among refugees. These interventions should target mainly those refugees who are living in Irbid, older adults, anxious and have high stress.